Individual
AMIRA ODISHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
026316
LA
2084P0800X
Psychiatry Physician
Primary
026316
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1571008
—
LA
Enumeration date
07/09/2006
Last updated
05/03/2024
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